What are the ethical implications of pharmacogenetics?

At first glance, pharmacogenomics appears to be an area where everyone benefits. Patients get medicines that work and suffer fewer side-effects; doctors can give better treatment; health service managers can save money if drugs are not given to people who will not respond to them. Are there any downsides?

Pharmacogenomics does not raise any new ethical issues, though it does re-emphasise some existing challenges. One area of concern is the handling of personal genetic data. Should that information remain private? How can privacy be maintained?

More generally, should patients be obliged to take a genetic test? It might be in their best interests, but should they have the freedom to decline? Would a doctor then prescribe an expensive medicine that might have no value? Or damaging side-effects?

In the future, a genetic test may also reveal more than just the likely response to a specific drug. Patients may feel that they do not want this additional information.

As with all genetic tests, the information is relevant not just to a patient but to other family members too. What principles should guide the sharing of such information in a family?

As well as individuals, pharmacogenetics has the potential to impact on groups. What will happen to people who cannot respond to any drug treatment for a given condition, who may end up with no medication? Companies may be unwilling to develop drugs for small groups of patients (or drug costs might be too high for healthcare providers to buy).

And grouping people according to their genes could have consequences too. People may end up being 'labelled' as not responding to a drug, or at risk of side-effects, which could have other effects in the life.

Pharmacogenetics offers many possible benefits. How it is introduced will be complex, however, and it will be important to be mindful of its possible ethical impact as the field develops.